Does Insurance Cover Drug Programs? Here’s what you Need to Know
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By: Harmony Staff

Clinically Reviewed by Dr. Deja Gilbert, PhD, LMHC, LPC

Updated on 03/28/2022

If you’re wondering if insurance cover drug programs, you’re in the right place. Generally, health insurance companies do provide coverage for drug rehab programs and many types of mental health treatment, as well. However, the exact amount or services covered does vary by the insurance plan that you have. The exact terms of your policy will determine any amount you have to cover if any.

Here at Harmony Healing NJ , we want everyone to get the drug rehab and mental health treatment they need. That is just one reason we are here to answer any questions you have about drug rehab, insurance coverage and services we perform that could be covered under your insurance plan.

Health Insurance Glossary

Before you read more about whether drug rehab and mental health treatments are covered under insurance policies, it may help to have a better idea of what certain health insurance terms mean.

DeductibleThe amount you need to pay for services before your insurance will cover the rest. For example, if you have a $1,000 deductible, you need to pay the first $1,000 of services, then your insurance will cover the rest of the bill. You may still have copayments or coinsurance to cover, however.
COPAYMENTThe amount you are responsible for paying from health care services after your deductible was met. For example, you might have a copayment of $40 per doctor appointment.
COINSURANCEThe percent of costs you need to pay for services after you meet your deductible.
OUT-OF-NETWORKAn organization or health care provider that doesn’t make any agreements with your health insurance company.
IN-NETWORK PROVIDERAn organization or health care provider that does have an agreement with your insurance company to offer care at discounted rates.
OUT-OF-POCKET AND OUT-OF-POCKET LIMITThe out-of-pocket expenses are the costs you are responsible for paying. The out-of-pocket limit is the mosts you will need to pay for health services each year.
PREMIUMThe amount you will may monthly or annually for your health coverage plan.

Now that you have a better idea of what each of these terms means, you can find out more on the coverage details for drug rehabilitation programs.

Will My Health Insurance Plan Cover Substance Abuse or Addiction Treatment?

There are many health insurance companies that do cover the costs for substance abuse and addiction rehab treatment programs. If you have an addiction to alcohol or drugs or you need help to manage or overcome a mental health disorder, you can reach out to us here at Harmony Healing NJ to find out if your insurance plan will pay for treatments. If so, we can let you know what costs you might be responsible for, if any. If not, we will discuss rates with you to help you get into treatment as soon as possible.

Rehab Coverage and Insurance Providers

The purpose of health insurance benefits is to make health care services more affordable to people and to make it more accessible, as well. Here at Harmony Healing NJ, we want everyone to know you aren’t alone. There is no shame in reaching out for help to overcome an addiction or mental health disorder. In fact, if you do have an addiction or mental health disorder and your insurance covers services (even partially), you should take advantage of that coverage as much as you can.

You can talk to your insurance company today to find out what addiction rehab or mental health services they will cover. However, we also want you to know that our team can be a true asset in helping you to find out whether you have insurance coverage for this purpose, as well.

Call us today at (833) 772-1295 to speak to someone from our addiction rehab team.

What Kinds of Drug Rehab Programs Do Insurance Plans Cover?

There isn’t just one type of drug rehab program that is generally covered by insurance plans. If your insurance plan includes substance abuse coverage, they will generally provide coverage for many different types of substance abuse or addiction treatments.

As you can see, there are often many addiction rehab treatment programs and services that are covered by insurance. If you are struggling with drug or alcohol abuse, don’t hesitate to reach out for help today at Harmony Healing NJ. Our team is ready to assist you in taking back control over your life.

Can You Attend an Addiction Rehab Program without Insurance Coverage?

If you aren’t covered for drug rehab services or you don’t have health insurance at all, don’t let this stop you from getting the addiction treatment you need. There are many state-funded and free addiction rehab programs available. Many states offer financial help to those who need this type of treatment, but who can’t cover it themselves.

There are also some treatment programs that accept payment plans, as well. You would need to speak directly with the rehab center staff to find out more about these options or to ask if there are any.

You may have some other options for covering substance abuse or addiction rehab treatments, too, which might include:

●                   Loans

●                   Payment plans

●                   Scholarships

●                   Family or friend financial support

●                   GoFundMe account

●                   Other fundraising efforts

There are ways to get drug rehab paid for if you are struggling with a drug addiction. Reach out to our team today to find out how to get enrolled into a drug rehab program.

What About the Affordable Care Act and Health Insurance Coverage?

The Affordable Care Act was signed as a law in March of 2010. The purpose of it was to make health insurance plans more accessible and affordable for everyone. The same law expanded access to Medicaid and supported innovative medical delivery techniques.

Under this act, nobody is supposed to be denied access to a health insurance plan, even if they do have a pre-existing condition such as a substance use disorder. The Affordable Care Act notes SUD (substance use disorder) as 1 of 10 elements of essential health benefits that every healthcare insurance company must provide. Basically, this means every health insurance company must provide coverage for mental health treatments, both for mental health care services and substance use disorders.

Can I Pay for Drug Rehab with More Than One Insurance Provider?

Yes, drug rehab can be paid for using more than one insurance provider. If you are going to use 2 or more health insurance plans to pay for any healthcare costs, you will have a primary insurance that picks up the costs first. Some of the people who might have dual insurance to pay for drug rehab include:

●                   Spouses who are covered under their own insurance plan and their husband/wive’s insurance plan, too

●                   Being under 26 years old and having their own plan and being covered by their parent’s insurance plan

●                   Being under 26 years old and having divorced parents who both have a health insurance plan for you

●                   Being 65 years old or older and having coverage through Medicare and an employer

If you have 2 or more health insurance plans, let us know. We can gladly tell you what each one of them will pay for drug rehab services and what you may have to pay, if anything, out-of-pocket.

What Are the Common Types of Health Insurance Plans and Benefits?

There are 3 common health insurance plans that will pay for drug rehab including:

●     HMO (health maintenance organization)

●     PPO (preferred provider organization)

●     POS (point of sale)

The HMO plans usually allow the patient to choose who their primary care doctor is and they can see that doctor for most medical needs. If the patient chooses an out-of-network provider, they will need a referral from their primary care doctor first. With HMOS, there is usually no deductible and a lower rate than PPOs.

PPO plans generally allow the patient to see health care providers that are in and out-of-network without any referrals. There is a bit more flexibility in these plans, meaning that you pay less money if you choose an in-network doctor, but you have the option of seeing someone out-of-netwrok. In addition, you don’t have to see a primary care doctor and don’t need a referral to go to a specialist. The monthly premium is usually higher with PPO plans, but you may have lower copays. You will likely have a higher deductible than an HMO plan, however.

The POS plans are similar to the HMO plans. The main difference is that sometimes, you can see a doctor out-of-network. The insurance company will determine when that is allowed.

No matter which type of insurance plan you have, please contact us here at Harmony Healing NJ if you need drug rehab services. We will help you figure out what deductible or copays you may have to pay in order to attend a drug addiction program.

What More Should I Know About Drug Addiction Coverage Costs?

Most health insurance companies will pay for some or all the alcohol or drug rehab program. The exact costs that they will cover and that you will have to pay depends on the level of treatment, insurance plan you have and any other circumstances specified in the plan. The amount of insurance coverage accepted really is based on each individual insurance policy. There is not just one cost that everyone will have to pay.

With this being said, addiction care is now accessible and affordable. Through Obamacare, insurance companies must treat it as it is – a mental health disability. In addition, insurance companies aren’t going to turn you down for coverage, per say, if you have an addiction due to genetics rather than envioronmental situations, or vice versa. The cause of your addiction won’t be a problem. It is just the same as with cancer or other physical health diagnosis.

The insurance companies also won’t discriminate based on what drugs were used, what they were mixed with, how long you were abusing them, what other conditions you might have, etc. If they cover substance use disorder treatments, that is it. They will pay the same regardless of how long you were abusing drugs, why you started abusing them and where you used them.

What Do Private Insurance Plans Have to Say About Drug Rehab Coverage?

As noted above, there are many different kinds of health insurance plans. Each one will have its own stipulations as to how much drug rehab costs they are going to pay for.

If you have a private insurance plan, it might be helpful to know that they see a benefit in offering drug rehab coverage to their clients. They believe that by offering drug rehab services, there will be fewer costs on their end for physical health problems as a result of drug abuse and fewer emergency room visit costs due to drug overdose. Lastly, private insurance plans see fewer organ transplants due to drug or alcohol abuse when they cover drug rehab in the first place.

If you do have a private insurance plan, don’t hesitate to reach out to us here at Harmony Healing NJ. We can help you find out what drug rehab coverage you have, for how long and then, we can get you the care you need.

What Mental Health Problems Do Insurance Plans Pay For?

The Affordable Care Act doesn’t just cover drug rehab. The insurance plans were also required to cover mental health issues, as well. They weren’t supposed to differentiate coverage for mental health concerns any different than they do physical health concerns. This means that if a plan has a copay for physical health doctor appointments of $20 each, then a doctor visit for depression or anxiety would also be $20 each.

While the parity laws don’t specifically state what mental health conditions the insurance plans must pay for, the rules are similar to that of drug rehab. If an insurance plan will provide care for mental health issues, they don’t typicaslly differentiate between what type of mental health condition you have, how long you have had it or why you were diagnosed with it in the first place. If they cover this type of care, it is covered regardless of all these questions.

If you have specific questions regarding your insurance coverage for mental health services, you can always contact your plan provider. However, if you need mental health treatment, you can also reach out to our Harmony Healing NJ team, so we can help you find out what copays you might have.

Will Medications for Drug Rehab and Mental Health Services Be Covered Under My Insurance Plan?

The medications that will be covered for drug rehab and mental health services under your insurance plan may vary depending on what plan you have. However, with this being said, there are some things that you may want to know about medications being covered by insurance plans when it comes to mental health and drug rehab treatments.

What Do People Need to Know About the Cost of Drug Rehab vs. The Costs of Addictions?

There is a great cost to every addiction – to the addict, their family, their friends, their community and to society in general. There is premature death, losing productivity at work, health issues, crime and many other costs associated with addiction. Research shows that addictions cost around $532 billion every year.

However, what is even more important than that fact, is that addiction treatment saves lives. If you or someone you know has an addiction to drugs or alcohol and are ready to get help, please reach out to our team here at Harmony Healing NJ today.

Whether you have a private insurance plan, one through your work, one through Affordable Care Act or another insurance plan, let our team help you determine what type of care you can get covered or how much you would have to pay. We want to help you turn your life around right away!

What Are Some Other Questions You Might Want to Ask?

There are some other questions that many people have asked that you may want to know and ask of our team, too. Some of these questions included:

●     How do I notify my insurance company that I need to receive drug rehab services?

●     How can I get financial assistance to pay for drug rehab if I don’t have insurance?

●     How much would outpatient rehab cost if I can’t or don’t want to attend inpatient treatment?

●     If my insurance plan covers drug rehab, can I attend an inpatient rehab program?

●     Does insurance pay for detox services?

●     What is the price for going to intensive outpatient or partial hospitalization programs?

●     What are the state-funded options for drug rehab?

If you have any of these questions or any others, please let our Harmony Healing NJ team know today. We would be happy to talk with you about anything regarding drug rehab or the services that we can provide to you.

Get Drug Rehab Services Today

Do you have an insurance plan? If so, no matter what type of insurance you have, our Harmony Healing NJ team can help find out what copays or deductibles you might have. We can find out whether drug rehab services are covered by your insurance and if so, what out-of-pocket expenses you might still have to pay, if any.

Don’t have insurance? Don’t let that stop you from saving your own life. Reach out to our treatment team to find other ways to get drug rehab paid, so you can start receiving treatments.

Contact us today, here at Harmony Healing NJ, to enroll in a drug rehab program right away.


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